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One Medical Application Per Community

1 Jun 2007

Doctor, I have this diaper rash...

I am Sreeram (Ram) Dhurjaty, and have been in the Medical Electronics and systems field for about 30 years. In this post, I would like to point out a powerful, medical, application of this robust platform for areas that are under-served.

There are sub-Saharan countries where the whole country has less medical equipment than the equipment lying idle in the corridors of hospitals such as Massachusetts General.

I see the One Laptop Per Child Children's Machine XO platform as a powerful platform that can enable telemedicine in underdeveloped areas by bringing medical diagnostics, and treatment options which may, otherwise, be inaccessible.

The OLPC XO platform is more powerful, by orders, of magnitude than computational engines used in medical devices such as patient and fetal monitors of the 80's. The video capabilities as well as mesh networking enables, with appropriate peripherals and front ends, the capacity to diagnose heart disease (EKG, Blood Pressure, Blood Oxygen) as well as monitoring of mothers during pregnancy. The video camera may be used to look different aspects of a person in order to assess gross determinations about the physical condition.

The ability to power the XO computer by mechanical means is also a powerful feature in addition to access to physicians and hospital via the mesh net. Internet Kiosks using PC platforms are being tested in countries such as India for telemedicine and eye care. Such kiosks may be located in Health Care Franchises such as in Kenya, as illustrated in "NOW" by PBS.

I realize that the primary application of the laptop is for educating children. However, this platform is still cost effective using the "buy two keep one" paradigm as described by Professor Nicholas Negroponte.

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10 Comments

Ram,
telemedicine via OLPC is a good idea. The question is how far you can realistically stretch it. What are the possibilities and what are the limitations? Will it just be for life saving first aid purpose or as the only means of health care at all.

Those countries with such a rudimentary health system you describe will not be able to buy XOs in large number for education. As you say they might only afford one laptop per village.
When you have one laptop per village the internet connection to the next doctor will have to be made by other means than the XO's mesh network whose range is 2 km max. Therefore it is not just the cost of the XOs but also for internet access infrastructure for each village. Is this realistic in those countries? Beside you also need electrical power for this internet connection.

Let's suppose you have an XO and an internet connection in every remote village. The XO alone can serve for verbal communication with a doctor and the camera can help the doctor to get a general idea of the patients condition and of large visible symptoms. However, no detailed close ups of local problem zones can be expected. Simple vision and hearing tests could be done, too.

For additional examinations you need peripheral devices that connect either to the microphone socket or the USB socket. I could easily imagine fever thermometers, pulse sensors, even electronic stethoscopes, blood pressure sensors, or simple EKG/EEG's. But I don't know whether ultrasonic examination via an XO during pregnancy is realistic?

With all this a doctor could diagnose quite a range of health problems. What about the treatment? Will the village have a stock of drugs and other treatment equipment? Will there be somebody trained to give shots or other treatments? (By the way Australia has something similar for emergency health care of remote cattle stations. They have a prepared emergency case with essential medicine and radio communication with the flying doctors.)

When you look at it such a village needs a lot more than just a cheap laptop. It needs power, telecommunication, peripheral examination devices, a stock of medicine, clean water, at least one trained medical aid person and an available doctor on the other end of the connection. I think that the cost of the laptop is not the crucial factor deciding whether telemedicine can be realized or not.

This is one area where I have great interest, being an advocate of "one telecentre per village" with its computer available for telemedicine as well as educational functions.

Given VOIP with telephone system connectivity and at least one USB port, it becomes possible to connect a digital camera (capable of the close-ups and flash illumination not commonly available on cell phones) so that a remote physician or practitioner can guide a local health worker in taking basic diagnostic information.

The USB port is quite high-bandwidth and useful, and would work (at 2.0 level) for ultrasound image display. Pointcare, one of the 2006 Tech museum Award laureates, offers a blood analyzer [http://www.pointcaretechnologies.net/newcontent/ourproduct/aurica.htm] for AIDS diagnosis designed for remote use. It includes a touch-screen computer connected to the analytic section through a USB cable. It would seem that with appropriate software this analyzer could be made available at a lower cost for connection to existing computers (which would have to be standardized and qualified for this use).

These kinds of uses are the ones which will develop the kind of local support that may very well not develop for OLPC in its constructivist mode. These one-computer-per-village (OCPV) uses produce revenue which can support someone who tends the machine and its internet link, and there is concrete economic benefit to be had simply through the telecommunication functions.

I would like to offer the use of my blog http://www.fonly.typepad.com for further detailed discussion of the medical applications of OLPV as well as others. These are the kinds of uses which I feel would suffer if OLPC renders suspect the whole concept of computers for rural areas of developing countries.

Lee,
I assume that such a ultrasonic device or a blood analyzer is much more expensive than a laptop (OLPC or standard). And you need somebody able to use it properly.

Of course telemedicine for remote villages should be done. But I am afraid that the availability of low priced XOs or OLPC servers will not overcome per se the main obstacles being all the other necessary expensive equipment and infrastructure like electricity and telecommunication.
Therefore you are right that this is not really a OLPC centered topic to be discussed here. Probably those villages, that are equipped with XOs for education, will show increasing acceptance due to the added value of telemedicine. However, I have not heard so far that the acceptance of XOs needs improvement in such villages.

Peripherals such as those for EKG., and Blood pressure can be made inexpensively. As for ultrasound, I was only referring to Fetal heart rate and not an ultrasound imaging system. These peripherals can be manufactured for tens of dollars (I have been there) and not as expensive as claimed. I agree an Ultrasound imaging transducer is very expensive, but we talking about basics. Even in the US fetal ultrasound stethoscopes are inexpensive.

Prof Ashok Jhunjhunwala of IIT Chennai, has developed a system using a desktop computer and a Kiosk.

Having a different application of OLPC in addition to its primary purpose can strengthen the appeal of the platform. Often technology end up being used in ways that were not the original intent of the technology.

Health care stands by itself, in addition to other issues. I feel that exploring other uses of the OLPC should not be a taboo in this forum. The appeal of a platform that can be powered by a pull rope is some thing that the classmate computer or any other computer cannot boast about. Power supply from the mains is elusive and fickle in villages, even in countries such as India.

It is not just the cost of the laptop that enables telemedicine, I agree. However this platform has many ingredients including robustness, power supply independence, mesh networking that makes it appealing.

I was not sure whether this forum was dedicated only to the technology of the XO as it relates to education or whether it has a broader scope of discussing the XO as it may be in the future. It is up to the editors and the owners of this forum to make it clear as to what should be legitimate to post vis a vis the XO in this discussion group.

- Some assistance in determining when medical assistance should be obtained if possible, followed by what you should do if medical assistance is not obtainable.

- Perhaps voice over of some kind so that family members who don't read could use it without having to put the child in the middle as an interpreter for sensitive medical conditions.

- Videos on basic home care skills and hygiene

Just as a start. The site could be set as a favorite in the browser or just set up as a mini-app of some kind.

I know that it's out of scope for the OLPC's basic educational goals, however the fact is that it is bringing internet access to places that didn't have it before - and it is an opportunity to provide health information to those who haven't had it in the past.

It's not as if this should occupy the machine for long enough periods to derail its main educational objective.

This particular idea is an example of a more general point. Olpc will be used for far more than eduction. The computer is the most flexible tool ever designed, and even more so when it is part of a network. The developing world has an enormous number of needs that are not being well met at present, and no doubt villagers and various experts will find a great many ways to use the oplc to help better meet such needs.

And that in turn has a major impact on the financial analysis of olpc. The correct way to determine if oplc is a good investment is not to look at just its eduational uses. One must also add in the many additional uses that will no doubt be developed. Looked at that way, oplc would seem to be perhaps the best bargain in the history of development.

It is great to find people interested in using the XO for dissemination of health information. Applications for the XO in the field of health care could be viewed from tow different perspectives.

1. With children around the world getting these gadgets, the time is ripe to disseminate health information to the community. For developing countries, fairly 'trivial' information on hand-washing, clean (a.k.a boiled water), personal hygiene, use of mosquito nets, etc. will save millions of lives. Diseases like malaria and water-borne infections kill more than heart disease and cancer. The possibilities for this are endless.

2. To train health-professionals: The XO would be vital tool to disseminate health information (in the form of offline ebooks, training videos as well as online courses, CMEs, etc) for health professionals in developing/under-developed countries. Over the past 18 months I have been working on e-learning initiatives for front-line healthcare professionals in Ethiopia. These non-doctor health professionals often work in remote rural areas with no contact with peers. While I agree that the XOs mesh networking would not be very useful in this scenario, imagine providing all the information that this isolated health officer needs to effectively manage his patients with the limited resources he/she has. One of the vital resources that is lacking in sub-Saharan Africa is up-to-date knowledge. Several scenarios are possible.

a. Health officers travel to their regional district hospital, monthly/bi-monthly, when they can update the information on their XOs.
b. XOs can be used at workshops and conferences that several NGOs and charities (including us) conduct. The mesh networking becomes a powerful tool in this scenario.
c. Health officers can use this to pass on vital statistics to the regional health administration offices.

3. XO addons, like fetal heart monitoring, flow cytometry (with applications in HIV patients) are invaluable in early diagnosis and treatment. Take fetal monitoring for example. If a health officer in a rural centre has the ability to diagnose problems with labor early, he/she can then either arrange transfer to a nearby (a.k.a >50-100kms) hospital or perform a caesarean section if the centre is equipped.

Increasingly health care delivery in sub-saharan africa is dependant on these peripheral centres and IT (maybe in the form of the XO) has a vital role to play.